Factors associated with complications among deep neck infections in a community-based hospital in Thailand

Deep neck infections (DNIs) are medical emergencies with potential for severe complications and mortality. Timely diagnosis and treatment are critical. This study examined the clinical characteristics and risk factors for complications in patients diagnosed with DNIs at a community-based hospital. A retrospective cohort study was conducted among patients aged ≥ 15 years diagnosed with DNIs at Chaophya Abhaibhubejhr Hospital, a 550-bed community-based tertiary referral center in Thailand, from January 2017 to December 2021. Data on demographics, comorbidities (hypertension, diabetes, and other underlying diseases), symptoms, infection sites, microbiology, treatment, and outcomes were extracted. Continuous variables were summarized as means ± standard deviations (SD) or medians with interquartile ranges (IQRs); categorical variables as counts and percentages. Group comparisons used Chi-square, Fisher’s exact, t-test, or Mann-Whitney U test as appropriate. Variables with p < 0.10 in bivariate analysis were included in multivariate logistic regression to identify independent predictors of complications, reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05. Of 226 patients, 59.7% were male, with a median age of 39.5 years (IQR 29–58). Comorbidities were present in 38.5%, most commonly hypertension (20.4%) and diabetes (19.0%). Odontogenic infections (54.9%) were the leading cause, typically presenting with neck pain and swelling (67.7%). The buccal, peritonsillar, and submandibular spaces were most frequently involved. Klebsiella pneumoniae was the most common pathogen (20%). Treatments included incision and drainage (44.6%), aspiration (12.4%), and intravenous antibiotics (42.9%). Complications occurred in 16.4%, with airway obstruction (7.1%) and sepsis (4.9%) most common. Independent predictors of complications were parapharyngeal space involvement (OR 43.3; 95% CI 3.0–628.0), multiple space involvement (OR 7.98; 95% CI 2.7–23.9), submental space involvement (OR 5.5; 95% CI 1.4–22.0), fever (OR 6.1; 95% CI 1.6–23.8), and anemia (OR 37.4; 95% CI 1.7–833.7). Neck pain and swelling were inversely associated (OR 0.2; 95% CI 0.04–0.9). Odontogenic infections are the most common cause of DNIs. Infections involving parapharyngeal, submental, or multiple spaces significantly increase the risk of complications. Early recognition and prompt intervention in high-risk patients are critical to improving outcomes.